The city of El Cajon did not respond to our request for comment on the family claims. For more information about police procedures they did respond sharing a policy manual given to officers. In part it says, in officer's decision to draw or exhibit a firearm should be based on the tactical situation and the officer's regional belief that there may be a substantial risk that the situation may escalate to the point where deadly force may be justified. That is from the alcohol policy manual on police procedures. Sometimes there are things on the ballot you don't know enough about so you leave it blank.KPBS reporter Allison St. John says this may be the case with the Tri-City medical center's board where voters are hearing confusing a disturbing allegations. Tri-City Hospital serve North County around Oceanside. Is ER treated 65,000 last year and 2500 babies were delivered at the hospital. One of my kids was born there. They did a standup job. Oceanside resident Brenda Walker says he hasn't picked candidates from the Board from his ballot. No. I haven't put much thought into that. Voters who pay attention may be concerned. Two CEOs have been let go by the Board both under mysterious circumstances in both with generous severance packages. Lawsuits this year alone over Medicare billing and new office building threatened to cost the district over $20 million. At a recent forum, one of nine candidates running for the board, Frank old, sounded the alarm. I believe that Tri-City is for all practical purposes, broke, for use of vernacular. I believe the hospital could be on the path to doomsday if it continues with the incumbents that we have guiding it or misguiding it as they are doing now. This is not true. Incumbent has a different campaign message. We have had three years of clean financial audit. This hospital is solid financially. We are going forward with a great plan. Carlsbad resident is one who gave up trying to make sense of it. I have no way of finding out anything about these people. I didn't even make a choice. Peterson doesn't think voters should be asked to choose who runs the hospital. It seems like it shouldn't be something we've oh people in. It should be something that is run by an organization that people. Most healthcare systems in San Diego are run by private, nonprofits not by publicly elected boards. They think Helfman says managing healthcare is complex. When I work with physicians and represent them with hospitals, they hire me because they don't understand the business aspects of healthcare. Calvin questions whether Republican elected board can steer the health care District 3 major hurdle ahead. The Challenger Tri-Cities is they will have to rebuild their facility in order to meet the earthquake requirements. Unfortunately, the financial performance is such that it will be difficult for them to raise the money. Even if they do raise the money to pay that money back in the form of interest payments. The head of San Diego's hospital association has a more positive take on Tri-Cities future especially because of the recent partnership agreement signed with UCSD. Healthcare organizations when adding services in new equipment and affiliating with other organizations, those are necessarily telltale signs of an organization teetering on the brink of bankruptcy or financial distress. I would say those are more signs of a solid organization. Zakk back is optimistic. I have a good idea of who I will vote for. He believes it's a good thing. I think it provides some of the best service possible. Public officials are accountable to the people. That is good for taxpayers. Brendan Walker sums things up this way. There's pros and cons either way. The weight it's working now, it works. Until it doesn't work, I think we are all right. Whoever the voters pick will have to navigate with a steady hand to survive in the choppy waters of the changing healthcare system. That was KPBS North County reporter Allison St. John joining me now. Who are the people running for the Tri-City health care district? There are nine candidates running for four places. Voters are faced with a lot of names. The most helpful thing has been flyers reaching voters. It shows two different slates. The three people being supported by the union representing nurses. The other Slate is from the North County leadership Council wishes fairly conservative backing Larry Shalit, Julie Nygard and a new candidate Dan Hughes who is a business owner setting -- saying he has experience in building hospitals and other parts of northern California, which may come in handy. You told us the fact that the Tri-Cities board is elected is unusual. Why are they elected by the public? Back in the 60s when it was originally put together by the public, they sold bonds repaid with public tax money. The facilities belong to the public rather than having investors put money into build a hospital, it's the taxpayer who owns the hospital. They also have the right to appoint the board that manages what is now becoming more like a health care district. More than just a hospital. Use a two CEOs were let go under mysterious circumstances. Doesn't this publicly elected board have to be accountable to the public? That is the issue. I feel like that is one of the things that makes it hard for voters to really know quite what is going on. There is not a lot of transparency about the reasons for these two CEOs being let go. The board will say it is to do with HR issues which have to remain confidential. It looks particular when in both cases, these CEOs were acclaimed as one of the most admired CEOs in the region by the business journal and subsequently the Board voted unanimously to let them go without really explaining why. How does Tri-City performance compared to other hospitals in San Diego County? There are different ways of measuring performance. If you compare them with sharp and scripts mercy which has twice as much income from patients, sharp and Scripps Mercy had operating revenues of 55 and $44 million a year. Tri-City only ended up the year with about $1.3 million. It's obviously not doing as well as many of the other hospitals around the region. The concern is about raising the money for this earthquake retrofit the hospital has to do. Hasn't Tri-City failed to pass bond measures before? This is it. Local people are not shown confidence in the hospital's ability to manage bonds that will be backed by tax money. Three times the district has tried to get bonds passed and three times it has failed. The Board has been invited by HUD to apply for a loan so that they can build an earthquake -- or hospital that will make earthquake standards by 2030. This is something that will be a an uphill financial struggle for any hospital, I think. All have had to face this. Tri-City still has that ahead. They are trying to stabilize its finances. The latest firing of its latest CEO was not good news for the average person watching this district. In other North County election news, one of the candidates in the Oceanside treasurers race, Gary Ernst, actually died in September. His name is still on the ballot. Can you tell us what's happening? This is a race that is quite important for Oceanside. There are 300 This is a race that is quite important for Oceanside. There are 300 million This is a race that is quite important for Oceanside. There are $300 million worth of bonds to be managed by the treasurer. He unfortunately died too late for the registrar of voters to take his name off the ballot. One might imagine an informed voter would perhaps vote for the other person on the ballot which is Nadine Scott. The Flyers are still going out saying advocating to vote for Gary Ernst. There is some question as to whether these flyers were already in the mail before his unfortunate death or whether they are still being sent out thanks to the support of Jerry Kern who is a city Council member and determined to keep Nadine Scott off and out of city politics because she was behind an attempted recall that failed against him. There is a lot of stuff going on with this race. What happens if he does win? If he were to win, the city Council would have a right to appoint him. There is a lot of money at stake. More than $300 million in bonds. The voters need to feel sure that whoever gets it will be qualified. It's fair enough if they want to vote for Gary Ernst as long as they know that he's dead and that the city Council will end up appointing someone. Those flyers do not make that point so it is very misleading to the voters who weren't informed. There has been an interesting development in the Board of Supervisors race in district 3. Dave Roberts sent out a mailer about Kristin Gaspar. Tell us about that mailer. This is a last-minute attack mailer from Dave Roberts who is the incumbent and facing very serious challenge from Kristin Gaspar. He has released a flyer accusing Gaspar's family physical therapy business of malpractice and elder abuse. This stems from a case 10 years old. Gaspar's attorney has fired back and called it libelous calling them to cease and desist and retract. Roberts has not done so. Another flyer has gone out. This is pretty much par for the course. We're seeing it in the presidential race. Last-minute attacks which the voters will have to weigh very carefully. I have been speaking with KPBS North County reporter Allison John.
Voters are faced with confusing messages from the candidates running for Tri-City's Medical Center board.
Tri-City Medical Center has served the North County coastal region around Oceanside, Carlsbad and Vista for 50 years. It’s one of North County’s largest employers with nearly 2,000 employees. Tri-City is a publicly-owned hospital that has evolved into a health-care district, with about 700 physicians and outpatient facilities.
Tri-City’s emergency room treated 65,000 people last year, and more than 2,500 babies were delivered at the hospital. Oceanside resident Brennon Walker‘s baby was one of them.
“One of my kids was born there,” he said. “They did a stand up job.”
But Walker said he hasn’t yet picked four candidates from the nine on his ballot to run Tri-City's board.
“No, I haven’t put much thought into that one,” he said. Walker added he would do some research now that it had been brought to his attention.
Voters who pay attention to what’s happening at their hospital may be disturbed:
Two CEO’s have been let go by the board in the last three years, both under mysterious circumstances and both with generous severance packages of more than $600,000. In 2009, the previous CEO left with a severance package of more than a $1 million. Lawsuits during the past year over Medicare billing and a new medical office building threaten to cost the district more than $20 million.
And there are other issues that have dogged Tri-City, including restraining orders to prevent previous board members from attending meetings.
Flyers with competing slates of candidates bear different messages.
The headline on one funded by SEIU, the union that represents the nurses at Tri-City, reads “Tri-City caught gaming the system." Another flyer, paid for by the North County Leadership Council reads, “The Future of Tri-City Hospital is Bright!”
Who is supporting the candidates?
Campaign contribution disclosures show campaigns for candidates Leigh Ann Grass and Marggie Castellano, plus incumbent Rosemarie Reno received $44,000 from SEIU.
The North County Leadership Council, an independent political action committee, has contributed $21,000 towards keeping incumbents Larry Schallock and Ramona Finnila on the board, and spent $7,000 to support Dan Hughes.
Hughes has also received $7,000 from the San Diego Republican Party and a Taxpayer Coalition.
Candidate Frank Gould raised about $4,000, Donna Rencsak raised $1,825 and Incumbent Julie Nygaard did not declare any contributions.
Competing messages
At a recent candidates’ forum shown on Oceanside’s cable channel, KOCT, one of the candidates running for the board, Frank Gould, sounded an alarm.
“I believe that Tri-City is for all practical purpose broke, to use the vernacular,” Gould said. “I believe the hospital could be on the path to doomsday if it continues with the incumbents we have guiding it — or misguiding it as they are doing now.”
But Ramona Finnila, one of the four incumbents who is hoping to keep her seat this year, disagreed.
“This is not true," she said. “We have had three years of a clean financial audit. I can tell you, based on my years of being here, that this hospital is solid financially. We’re going forward with a great plan."
Can voters make sense of it?
Carlsbad resident Julie Peterson is one voter who gave up trying to make sense of it all.
“I had no way of finding out anything about these people,” she said. "So I actually left it off — I didn’t even make a choice.”
Peterson thinks voters should not be asked to choose who runs their hospital.
“It should be something that is run by an organization, not the people,” she said.
Public vs. private
Many hospitals and health-care systems in San Diego, like Sharp and Scripps, are run by private nonprofits, rather than by publicly elected boards.
Health care consultant Nathan Kaufman said health care is getting so complex, it needs people with specialized knowledge to run the systems.
“When I work with physicians and represent them with hospitals, they hire me because even they don’t understand the business aspects of health care," Kaufman said. “The bottom line is, if you looks at the health care systems that are performing the best in San Diego, they are not the public health care systems."
Kaufman cites the Medicare cost reports from the American Hospital Directory that compare Tri-City with Scripps Mercy and Sharp Grossmont.
Scripps Mercy and Sharp Grossmont hospitals each have patient revenues and budgets twice the size of Tri-City. But their net incomes were $44 million and $51 million respectively last year, compared to Tri-City’s net income of $1.6 million.
Grossmont Hospital in La Mesa is also publicly owned. But in 1991 the hospital was leased to Sharp, a private nonprofit, whose management is appointed rather than elected. Since then, satisfied voters have doubled the length of the lease to 30 years.
Another publicly-run hospital in North County, Palomar Health, has managed to avoid some of the personnel issues and litigation that have plagued Tri-City. Palomar was able to convince voters in 2006 to approve a bond measure, which resulted in a brand new hospital that now towers over Escondido and meets required earthquake codes.
Tri-City has tried three times to convince voters to pass a bond to rebuild the hospital. It failed each time to get the needed two-thirds approval, most recently in 2008. Tri-City is currently applying to HUD for a loan to meet the requirement to make the hospital earthquake safe by 2030.
Kaufman questioned whether a publicly elected board could effectively steer the healthcare district through the financial hurdles ahead.
“The challenge you have at Tri-City is they have to rebuilt their facility in order to meet earthquake standards,” he said, ”and unfortunately their financial performance is such that it will be difficult for them to raise the money.“
Looking on the bright side
But the head of the San Diego’s Hospital Association, Dimitrios Alexious, has a more positive take on Tri City’s future, especially because of a recent partnership agreement the district has signed with UC San Diego.
“Health care organizations — when they are adding services, adding new equipment, affiliating with other organizations, partnering in the community — those aren’t tell tale signs of an organization who’s teetering on the brink of bankruptcy or financial distress,” Alexious said.
Oceanside resident Zac Beck is also optimistic. Beck, who is Oceanside’s city clerk, was happy to offer his opinion when asked during a chance meeting on his way to the gym. He admitted to being a well-informed voter, perhaps more than most.
“I do have a good idea of who I’m going to vote for,” he said.
Beck believes it’s a good thing his hospital is controlled by a publicly elected board.
“I think you’re going to receive some of the best services possible because the public officials elected to that board are accountable to the people who are receiving the healthcare services directly," he said. "I do believe that’s an important thing.”
Voter Brennon Walker summed things up this way.
“The way it works now, it works,” he said, “so until it doesn’t work, I think we’re alright.“
Whoever voters pick to run Tri-City will have to navigate with a steady hand to survive in the choppy waters of the changing health care system.
